{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:39:12Z","timestamp":1787841552385,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale:<\/jats:title>\n                    <jats:p>Mandibular osteomyelitis is a common complication in pycnodysostosis; however, spontaneous atlas fracture has not been previously reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Concerns:<\/jats:title>\n                    <jats:p>Persistent mandibular pain, swelling, and purulent discharge following tooth extraction, along with recent cervical discomfort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Diagnosis:<\/jats:title>\n                    <jats:p>Left mandibular osteomyelitis and type 3 atlas (C1) fracture in a patient with a prior diagnosis of pycnodysostosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Treatment:<\/jats:title>\n                    <jats:p>Cervical immobilisation with a Philadelphia collar for 8 weeks, sequestrectomy under local anaesthesia, irrigation, debridement and targeted antibiotics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes:<\/jats:title>\n                    <jats:p>Favorable progress with no signs of infection or cervical symptoms after 6 months, along with partial bone healing in the mandible and stabilization of the C1 fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Take-away Lessons:<\/jats:title>\n                    <jats:p>In patients with pycnodysostosis, maxillofacial procedures must include prior cervical evaluation. Vertebral fractures may occur without evident trauma and present with minimal symptoms, posing a high clinical risk if undetected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ams.ams_21_25","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T08:01:31Z","timestamp":1760688091000},"page":"241-244","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous Fracture of the Atlas in a Patient with Pycnodysostosis and Mandibular Osteomyelitis - A Case Report"],"prefix":"10.4103","volume":"15","author":[{"given":"Pablo Andr\u00e9s","family":"Crespo-Reinoso","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Cuenca, Cuenca, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika Paola","family":"Padilla-Vi\u00f1anzaca","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Cuenca, Cuenca, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"R1-20260127","doi-asserted-by":"crossref","first-page":"116674","DOI":"10.1016\/j.bone.2023.116674","article-title":"Pycnodysostosis in children and adults","volume":"169","author":"Hald","year":"2023","journal-title":"Bone"},{"key":"R2-20260127","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.bjorl.2020.12.009","article-title":"Osteomyelitis of the jaws in patients with pycnodysostosis: A systematic review","volume":"87","author":"de Fran\u00e7a","year":"2021","journal-title":"Braz J 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Dent"},{"key":"R9-20260127","doi-asserted-by":"crossref","first-page":"107414","DOI":"10.1016\/j.clineuro.2022.107414","article-title":"Traumatic atlas fracture patients comprise two subpopulations with distinct demographics and mechanisms of injury","volume":"221","author":"Cloney","year":"2022","journal-title":"Clin Neurol Neurosurg"},{"key":"R10-20260127","first-page":"100224","article-title":"Management of combined atlas and axis fractures: A systematic review","volume":"14","author":"Mohile","year":"2023","journal-title":"N Am Spine Soc J"}],"container-title":["Annals of Maxillofacial 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